Provider Demographics
NPI:1548750219
Name:GRILLO, JAMIE SUZANNE (MS SPECIAL EDUCATION)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:SUZANNE
Last Name:GRILLO
Suffix:
Gender:F
Credentials:MS SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10827
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-2827
Mailing Address - Country:US
Mailing Address - Phone:850-521-0242
Mailing Address - Fax:850-521-1973
Practice Address - Street 1:9005 OVERLOOK BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5269
Practice Address - Country:US
Practice Address - Phone:615-733-4651
Practice Address - Fax:646-859-4440
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst